Friday, June 12, 2020

She’s Not Handling This Well


The patient is a 65 year-old woman with a two-month history of hand dermatitis.  She has had no new medications in a year and has been laid off from a job in sales due to Covid 19.  After 25 years, she’s had to sell her house and is moving into an apartment in three days time.  Holding up her hands up in front of her, without irony, she said, “I’m not handling this situation well.”


Clinical Exam: The palms of both hands are dry with marked scale plates.  The dorsae of the hands are normal.  There are no other cutaneous findings.  In the photo above, there is a suggestion of Dennie-Morgan Lines.  Her feet are normal.


Discussion:  In the differential diagnosis I considered traumiterative hand dermatitis, psoriasis, contact dermatitis, tinea (KOH was negative).
But I keep wondering about that phrase in English, “She can’t handle it.”  Why is that aphorism there?  Did the Ancients know something we’ve forgotten?

She will be treated with clobetasol ointment employed with a “Soak and Smear” protocol.  If she does not clear by a few weeks after her move, biopsy, patch testing, and a medical workup will be pursued, but she has other things on her plate just now.

3 comments:

  1. Prof. Bhushan KumarJune 12, 2020

    Extra dryness and peeling seems to be related to obsessive hygiene and frequent washing of hands.
    Chronic hand dermatitis may be considered- but not seriously.
    Frequent application of emollients / Vaseline preferably under occlusion (easily possible at night) with some anti depressants should help.

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  2. Khalifa Sharquie, Baghdad: My first diagnosis is psoriasis but the old teachings say whenever see rash in one palm or hand or in one sole think first about fungal infection?But nowadays even the rash is symmetrical affecting both palms or soles think about fungus.we got this experience from daily practice as now we have severe outbreak of all types of fungus.Hence fungal infection is now considered as great imitator .Scrape for fungus should be repeated many times to confirm the diagnosis otherwise could be negative and even culture might negative and should be repeated.
    So my policy of therapy in these questionable diagnosis I give combination ointment containing antifungal and steroids together with oral nizirol tab plus other preventive measures like wearing gloves.This therapy is good for psoriasis and and curable for fungus infection.

    ReplyDelete
  3. Richard Sontheimer (Utah) wrote: would vote for Covid-induced and excessive handwashing-induced flare of underlying pre-existing atopic or psoriatic immunologic state.

    ReplyDelete

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